Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

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Challenging the uncertainty of COVID-19 in rural community based medical education for family medicine: A thematic analysis

10.21203/rs.3.rs-109214/v1 ◽

2020 ◽

Author(s):

Ryuichi Ohta ◽

Yoshinori Ryu ◽

Chiaki Sano

Keyword(s):

Medical Education ◽

Rural Communities ◽

Family Medicine ◽

Direct Observation ◽

Rural Community ◽

Thematic Analysis ◽

Rural Areas ◽

Community Hospitals ◽

Rural Medicine ◽

Postgraduate Students

Abstract BackgroundCommunity based medical education (CBME) enriches undergraduate and postgraduate students’ perspectives, especially in rural settings. For the continuity of rural CBME in Japan, the present disruption caused by the coronavirus must be overcome to drive CBME and educate future family physicians adequately in rural community hospitals. In this study, we examine the challenges faced by and solutions for sustainable CBME in community hospitals during the COVID-19 pandemic.MethodsA qualitative study was performed with CBME stakeholders in a community hospital. First, direct observation was performed by the first author. Through this method, field and reflection notes were taken by observing and interviewing the dean, medical teachers, nurses, medical students, a medical clerk, and rural citizens in the hospital and its surrounding rural communities from April 1 to September 30, 2020. Interviews were recorded, and their contents were transcribed verbatim. The authors analyzed the transcriptions using on a thematic analysis.ResultsOverall, 31 pages of field and reflection notes were collated through direct observation and used for analysis. Five physicians, eight nurses, one clerk, fourteen medical trainees, and three rural citizens were interviewed. Through the thematic analysis, three themes emerged: the uncertainty of COVID-19, an overwhelming fear within medical institutions, and motivation and determination to continue providing CBME.ConclusionRural CBME for family medicine should be continued for the sustainability of rural medicine, even during the COVID-19 pandemic. The end of the pandemic cannot be foreseen, and CBME in rural areas should be continued to serve its true purpose by carefully considering precautions and through continuous dialogue between stakeholders and medical educators.

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Family Medicine and Emergency Redeployment: Unrealized Potential

Family Medicine ◽

10.22454/fammed.2022.404532 ◽

2022 ◽

Vol 54 (1) ◽

pp. 44-46

Author(s):

Hoon Byun ◽

John M. Westfall

Keyword(s):

Family Medicine ◽

Residency Training ◽

Rural Areas ◽

Family Physicians ◽

Physician Assistants ◽

Scope Of Practice ◽

Separate Analysis ◽

Medicare Beneficiaries ◽

Emergency Rooms ◽

Training Requirements

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

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Redesigning Residency Training: Summary Findings From the Preparing the Personal Physician for Practice (P4) Project

Family Medicine ◽

10.22454/fammed.2018.829131 ◽

2018 ◽

Vol 50 (7) ◽

pp. 503-517 ◽

Cited By ~ 1

Author(s):

Patricia A. Carney ◽

M. Patrice Eiff ◽

Elaine Waller ◽

Samuel M. Jones ◽

Larry A. Green

Keyword(s):

Family Medicine ◽

Residency Training ◽

Narrative Analysis ◽

Scope Of Practice ◽

Comparative Case Study ◽

Patient Centered ◽

Successful Model ◽

Personal Physician ◽

Medicine Education

Background and Objectives: The Preparing the Personal Physician for Practice (P4) project (2007 to 2014) involved a comparative case study of experiments conducted by 14 selected family medicine programs designed to evaluate new models of residency education that aligned with the patient-centered medical home (PCMH). Changes in length, structure, content, and location of training were studied. Methods: We conducted both a critical review of P4 published Evaluation Center and site-specific papers and a qualitative narrative analysis of process reports compiled throughout the project. We mapped key findings from P4 to results obtained from a survey of program directors on their top 10 “need to know” areas in family medicine education. Results: Collectively, 830 unique residents took part in P4, which explored 80 hypotheses regarding 44 innovations. To date, 39 papers have resulted from P4 work, with the P4 Evaluation Center producing 17 manuscripts and faculty at individual sites producing 22 manuscripts. P4 investigators delivered 21 presentations and faculty from P4 participating programs delivered 133 presentations at national meetings. For brevity, we present findings derived from the analyses of project findings according to the following categories: (1) how residency training aligned with PCMH; (2) educational redesign and assessment; (3) methods of financing new residency experiences; (4) length of training; (5) scope of practice; and (6) setting standards for conducting multisite educational research. Conclusions: The P4 project was a successful model for multisite graduate medical education research. Insights gained from the P4 project could help family medicine educators with future residency program redesign.

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Strengths and Challenges for Medical Students and Residents in Rural Japan

Family Medicine ◽

10.22454/fammed.2021.308872 ◽

2021 ◽

Vol 53 (1) ◽

pp. 32-38

Author(s):

Ryuichi Ohta ◽

Yoshinori Ryu ◽

Takuji Katsube ◽

Jun Otani ◽

Yoshihiro Moriwaki

Keyword(s):

Medical Students ◽

Family Medicine ◽

Rural Community ◽

Rural Areas ◽

Educational Background ◽

Legitimate Peripheral Participation ◽

Community Hospitals ◽

Medical Issues ◽

Cognitive Apprenticeships ◽

Peripheral Participation

Background and Objectives: In Japan, family medicine training is driven by community-based medical education (CBME) and is often provided in rural community hospitals and clinics. Although CBME’s positive relationship to family medicine in rural community hospitals is proven, the learning processes of medical students and residents in rural community hospitals needs investigating. The objective of this study was to reveal medical students’ and residents’ changing motivations and learning behaviors, as well as the factors underpinning their transition between medical schools or tertiary hospitals and rural community hospitals. Methods: Over 2 years, the researchers conducted one-on-one interviews with 50 medical students and 30 residents participating in family medicine training at a rural community hospital, and analyzed the difficulties the participants encountered and how they overcame them. The interviews were audio recorded and transcribed verbatim. We used grounded theory in the data analysis to clarify the findings. Results: Three key themes emerged: educational background, changing environment, and factors driving the learning cycle. Participants had difficulties in overcoming differences between their previous education and their CBME, particularly regarding expected roles and the variety of medical issues. They overcame their difficulties through cognitive apprenticeships and legitimate peripheral participation enhanced by daily reflection. Conclusions: In rural community hospitals, participants struggled to adapt to the wider practice range and the more interactive relationship with educators. Cognitive apprenticeships and legitimate peripheral participation, supported by constant reflection between learners and clinical teachers, can facilitate learning, leading to more effective learning and practice of family medicine in rural areas.

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SOBRAMFA has promoted family medicine education in Brazil since 1992

Medical Education ◽

10.1111/j.1365-2923.2007.02929.x ◽

2007 ◽

Vol 42 (1) ◽

pp. 115-115 ◽

Cited By ~ 1

Author(s):

Pablo González Blasco ◽

Adriana F T Roncoletta ◽

Graziela Moreto ◽

Maria A C de Benedetto ◽

Marcelo Levites ◽

...

Keyword(s):

Family Medicine ◽

Education In Brazil ◽

Medicine Education

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Challenges and solutions in nurse practitioners’ work for interprofessional collaboration at rural community hospitals: The grounded theory approach

Journal of Interprofessional Education & Practice ◽

10.1016/j.xjep.2021.100421 ◽

2021 ◽

Vol 23 ◽

pp. 100421

Author(s):

Ryuichi Ohta ◽

Satoko Maejima

Keyword(s):

Grounded Theory ◽

Rural Community ◽

Nurse Practitioners ◽

Interprofessional Collaboration ◽

Theory Approach ◽

Community Hospitals ◽

Grounded Theory Approach

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Family Medicine Education

Family Medicine ◽

10.1007/978-1-4757-3999-2_5 ◽

1978 ◽

pp. 29-30

Author(s):

Robert B. Taylor

Keyword(s):

Family Medicine ◽

Medicine Education

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Emergency medicine as a career choice: a descriptive study of Canadian medical students

CJEM ◽

10.1017/s1481803500011210 ◽

2009 ◽

Vol 11 (03) ◽

pp. 196-206 ◽

Cited By ~ 12

Author(s):

Ian M. Scott ◽

Riyad B. Abu-Laban ◽

Margot C. Gowans ◽

Bruce J. Wright ◽

Fraser R. Brenneis

Keyword(s):

Emergency Medicine ◽

Family Medicine ◽

Medical School ◽

Career Choice ◽

Demographic Data ◽

School Entry ◽

Social Orientation ◽

Scope Of Practice ◽

Medical Specialties ◽

Hospital Orientation

ABSTRACTBackground:Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine.Methods:We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data.Results:Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%–7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important.Conclusion:Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.

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Nurturing the Student, Sustaining the Mission: 20 Years of the International/Inner-City/Rural Preceptorship Program

Family Medicine ◽

10.22454/fammed.2019.358223 ◽

2019 ◽

Vol 51 (10) ◽

pp. 823-829

Author(s):

Yeri Park ◽

Mark H. Ryan ◽

Sally A. Santen ◽

Roy Sabo ◽

Courtney Blondino ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Inner City ◽

Rural Areas ◽

Self Determination Theory ◽

Care Physician ◽

Self Determination ◽

Medically Underserved ◽

Medically Underserved Areas ◽

Virginia Commonwealth University

Background and Objectives: Specialized medical school educational tracks aim to increase the primary care workforce. The International/Inner-City/Rural Preceptorship (I2CRP) Program is unique in addressing multiple communities, a large cohort and applying the Self Determination Theory framework. This study examined program impact by analyzing the numbers of graduates matched into primary care and practicing in medically underserved communities. Methods: We compared the match list of I2CRP graduates between 2000 and 2017 (n=204) to non-I2CRP Virginia Commonwealth University School of Medicine (VCU SOM) graduates (n=3,037). We analyzed the matches into primary care, National Health Service Corps (NHSC) priority specialties, and NHSC priority plus general surgery. We searched a federal database to determine which graduates are practicing in workforce shortage areas. Results: Many more I2CRP graduates matched to primary care (71.1%), compared to non-I2CRP graduates (38.2%; P<.001). Within primary care, I2CRP graduates matched to family medicine more frequently than non-I2CRP graduates (36.3% vs 8.4%). Eighteen percent of posttraining I2CRP graduates work in rural areas and 41% work in medically underserved areas. Conclusions: I2CRP graduates are more likely to match to family medicine and primary care. I2CRP curriculum nurtures new medical students’ interest in primary care, and self-determination theory provides a framework to organize the program curriculum. The program’s impact endures as evidenced by participants’ continued work in underserved areas after residency. Increasing support for such programs may help address the primary care physician shortage in medically underserved areas.

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